Supporting Documentation · Jan 8, 2025
Exhibit A 1 Amendment application filed 4 10 24
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ger Daniel Last Name First Name Middle Initial Home Street Address 2 Ely Ct. Number Street Name P.O. Box # Municipality Livingston state__NJ RSENS TESTO 58 1967 Social Security Number_219 -__5918 Date of girth 10, 25 / Home telephone number (__ 273 _)_ 992 -_4913 Area Exchange Number Office telephone number ( ) - Area Exchange Number % of business owned or controlled Number of shares Check position that applies Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary __X_ Other (specify) ___ Member, Board of Governors
Page 10A STATE ASSIGNED LICENSE NUMBER PLEASE TYPE OR PRINT ALL INFORMATION 0722. 33. (915 O01 ALL APPLICANTS ANSWER THE FOLLOWING [ADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Complete this page in full LIMITED PARTNERSHIPS: All information about a general partner or partners of a limited partnership must be reported, whether the general partner is an individual or a corporation. A list of the names and addresses of all limited partners must be submitted as an attachment to this application with an identification of the percentage of each limited partner as it relates to total ownership of the business entity to be licensed CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation under license or to be licensed must have been reported on Page 10. Information on this Page, 10A, will identify all officers, directors and stockholders holding one percent or more of the shares of the respective company. Club licenses must list names of officers and directors and attach a current membership list TESCO SSSI OSI III IIIS II III I IOI III III I I TI I TIT TT TI TOS IS I IS I II SII II SII I SSSI SII ISIS IIIS SISOS SI SSI SS IIS NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A CORPORATION OR PARTNERSHIP) Essex County Country Club Name of individual (last name fst. stockholder, partner. offger or director: i ason Kirscl Last Name inst Name Middle Initial Home Street Address 3222 Runnymede RE: Number Street Name P.O. Box # Municipality Essex Fells State NJ zip 07021 Se 8 1974 Social Security Number __ 150 __72 =, 7097 Date of Birth op / 973 728 5166 Home telephone number ( ) * Area Exchange Number Office telephone number ( ) - ‘Area Exchange Number % of business owned or controlled Number of shares Check position that applies Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary X other (specify) Member, Board of Governors Name of individual (last name first) , stockholder, partner, officer or director: Meglio Steven Last Name First Name Middle Initial Home Street Address 60 Roseland Ave. Number Street Name P.O. Box # Municipality __ Caldwell state__NJ Zip - 1 26 1961 Social Security Number__ 136-56 Aedes Date of Birth / / Home telephone
dle Initial Home Street Address 60 Roseland Ave. Number Street Name P.O. Box # Municipality __ Caldwell state__NJ Zip - 1 26 1961 Social Security Number__ 136-56 Aedes Date of Birth / / Home telephone number ( 973 ) 226 - 4300 Area Exchange Number Office telephone number ( ) 2 Area Exchange Number % of business owned or controlled Number of shares Check position that applies Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Member, Board of Governors Beneficiary Other (specify)
Page 11 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER OTB 33 - ols. Oo i AFFIDAVIT LICENSE PERIOD APPLIED FOR erom_AD23 To a2catt DATE State of New Serces, County of ESQ As provided by law (R.S. 33:1-35) ) ) ) ss ) ) (Check One) 1. The Individual Applicant 2, Members of the Partnership Applicant > Joseph Ke Y pALanagec o Essex County Country Club. (President/Vice-Pfegident) (Corporation dr Club Name) | consent(s) that the licensed premises and all portions of the building constituting the licensed premises, including all rooms, cellars, closets, out-buildings, passageways, vaults, yards, attics and every part of the structure of which the licensed premises are a part and all buildings used in connection therewith which are in his/her/their possession or under his/her/their control, may be inspected and searched without warrant at all hours by the Director of the Division of Alcoholic Beverage Control, his or her duly authorized deputies, inspectors or investigators and all other sworn law enforcement officers, and being duly sworn according to law, upon his/her/their oath(s), depose(s) and say(s) that he/she is (they are) the person(s) duly authorized to sign the application, that in instance of corporate ownership, the signator is authorized by corporate resolution to sign on behalf of the corporations; and that the contents of this application represent complete disclosure of the fact, and that the contents of this application are true. (Signature of individual Agent / Sole Proprieton (Corporations Only) Attestation by Corporate Secretary (Partnership Name) (Signature of Partner) Attest Essex County Contry Club Corporate Name (Signature of Partner) By Secretary (Signature of Forporate Presi¥ent or Vice President) (Signature of Partner) Signature Affix Corporate Seal (Signature of Partner) Sworn to and subscribed before me this O day of Mach _ 20 JO A Podge ieee of Officer Administering Oath) BY DULY AUTHORIZED lisa @ k Borate ou | AFFIDAVIT MUST BE SIGNED HERE --. --- > NOTARY PUBLIC (Printed Name of Officer Administering Oatty OR AN ATTORNEY-AT-LAW Attormey - Ab - - Law OF NEW JERSEY Ciitle of abe aga Oath) (Date of Expiration of oP Ni Ow \ersey Commission, if applicable)
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law CHIESA SHAHINIAN & GIANTOMASI PC 105 Eisenhower Parkway, Roseland, NJ 07068 csglaw.com LISA R. BARATA \barata@csglaw.com © 973.530.2343 F 973.325.1501 April 9, 2024 Via Hand Delivery Karen Carnevale Municipal Clerk, West Orange Township 66 Main Street West Orange, New Jersey 07052 Re: | Essex County Country Club - Application Amendment Plenary Retail Consumption License 0722-33-015 Dear Ms. Carnevale: In accordance with N.J.A.C. 13:2-2.14, | attach an original and two copies of a twelve page application amendment for the Essex County Country Club, license number 0722-33-015. Please feel free to contact me with any questions or concerns regarding same. Very truly yours, OW Lisa R. Barata LRB Enclosures NEW JERSEY NEW YORK 4855-9418-3094.v1
File revisions (1)
- Sep 29, 2026
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